Emotional memory affects behavior of persons with Alzheimer's

Our feelings and emotions color our lives from birth to death. Each of us ebb and flow through cycles of joy, fear, anger and loss. We know the feeling of love and we can sense alienation. This deeply human emotional experience is unequivocally true for persons affected by Alzheimer's.

Our emotional life comes from the inner part of our brain called the amygdala. The amygdala is more instinctive than the thinking part of the brain called the cortex. The amygdala is kept in check by the cortex of the brain, in particular the frontal lobe.

This means that a person living with Alzheimer's will experience emotions, but at times may have less ability to regulate them. As a result, they're often labeled as having irrational or inappropriate behavior.

Some of you may have experienced the person you know living with dementia seeming upset for no apparent reason. People with dementia often forget the circumstances that caused a strong feeling. But they may retain the feelings associated with the incident for some time.

For example, if your spouse reacted irritable or angry toward you last week because of something you did or didn't do, that resentment or feeling might stay around for a while even though the reason for the feeling is forgotten.

It's been said that it's easier to erase a bad memory than the emotion behind that bad memory. For persons living with dementia, this is certainly the case.

This summer at the Alzheimer's Association International Conference in Boston, I had a wonderful opportunity to hear Dr. Steven Sabat present and discuss his work aimed at understanding dementia from the inside out.

Dr. Sabat is a member of Georgetown University's Psychology Department and the author of "The Experience of Alzheimer's Disease: Life Through a Tangled Veil Dementia (2001), and "Mind, Meaning and the Person" (2005).

He finds that people with Alzheimer's can form new emotional associations-memories-related to how they're treated or by an experience. Then, sometime later, they may exhibit the associated emotion, although they can't consciously recall the incident related to that emotion.

In an excellent book called "Excellence in Dementia Care: Principles and Practice", edited by Murna Downs and Barbara Bowers (2008), the following scenario offers an example:

"You are a staff member at a day center that serves people including those diagnosed with dementia. The spouse of one of the participants tells you about his wife, "Her Alzheimer's is getting worse; yesterday after I picked her up at the day center, she became irrationally hostile toward me, wouldn't speak to me or look at me during the evening."

What do you say? What do you think? Consider what you might think if you also knew the larger context of the scenario:

When the husband arrived to pick up his wife, she was standing in the hallway conversing with others, including staff members. The husband joined in the conversation but, as his wife was talking, he began to tuck her turtleneck top into her trousers. As he did this in front of others, thinking (incorrectly) that she'd forgotten to do so herself, she was clearly humiliated, her eyes bulging out of their sockets so to speak, but this went unnoticed by the husband. She reacted toward him with anger, but her anger was anything but 'irrational.' Indeed, one could quite easily refer to her reaction as 'righteous indignation' instead or 'irrational hostility.' "

According to the authors of the book, the woman was displaying righteous indignation; a reactive emotion of anger over perceived mistreatment.

This story reflects the importance of knowing the full context in which a person acts. The woman's emotional reaction to her husband was actually befitting to the situation. Yet someone with dementia could be commonly labeled as irrational or hostile-his or her undesirable behavior attributed merely to the brain damage due to Alzheimer's.

Emotional behaviors occur for a reason. The wife in the story illustrates the preservation of implicit memory, also called procedural memory. She exhibited behavior appropriate to an emotion associated with an experience she had, even though she can't consciously remember the experience.

In other words, she was unable to recall or articulate the details of the situation that caused her to be angry. To do so would require explicit memory, also called declarative memory. This is a function of the brain highly impacted by Alzheimer's.

I'll continue to advocate for treating people as people and seeing the whole person, not just a diagnosis or label. Those living with dementia know, feel, and experience life much more than we appreciate. They know when they're being treated with respect and when they're not.

Once we believe this, it completely changes us-the way we communicate, the way we interact, and the way we see ourselves in this interconnected web of life.

My mother has been diagnosed with Alzheimer's. My brother and his wife and their infant moved into my parents large home when Theirs. was hit by hurricane Sandy. They were only supposed to stay 6 months. It's now been 3 years. They are very messy and the wife still doesn't speak English even though she's been in the US for three years. My mom is always stressing about the mess. They do nota monitor her meds and do not keep the refrigerator stocked. Oh do they have a babysitter come everyday even though the wife doesn't work. The baby is 7 months old! I'm concerned there is too much stress on my mom. My dad has advanced Parkinson's too. I've talked to all of them about the meds even translating to my sister-in-law. My dad can barely take care of himself so I do not expect him to distribute the meds. But my sister-in-law was in Columbia for six weeks and my mother was noticeably better. There now back and my mom is starting to showalarming changes in her memory. I'm scared to death and it's like talking to a wall with my brother sister-in-law and dad. Assistance would be appreciated including documentation of stress on an Alzheimer's patient

Becky

April 24, 2015 3:14 a.m.

I couldn't agree with you more.

Annie McGuinness

October 4, 2013 4:13 p.m.

I believe it is important for children to understand Alzheimer's disease so they can still interact lovingly with family members who have this disease. I am a 17 year old college junior, Alzheimer's researcher, and Alzheimer's advocate.I grew up as a caregiver to my great grandmother who had Alzheimer's disease. After her death, I founded a nonprofit organization that has distributed over 24,000 puzzles to Alzheimer's facilities. Recently, the book I coauthored explaining Alzheimer's disease to children became available on Amazon.My hope was to provide some helpful coping mechanisms to the many children dealing with Alzheimer's disease among their family members. 50 percent of the profits from this book will go to Alzheimer's causes. I think this book could help a lot of children and families.&quot;Why Did Grandma Put Her Underwear in Refrigerator? A Book Explaining Alzheimer's Disease to Children.&quot; http://amzn.to/13FYYxh

Max

September 24, 2013 4:08 a.m.

to Sue, I forgot the control for fluid. It can be it is not enough and there were hallucinations. Because the brain has not enough food and so the biochemicals are not so good builded. So the connections in the brain will be wrong.

Susanngab

September 24, 2013 4:02 a.m.

to Sue, it can be that the person has inside a dialog. It is from time before, and not been worked. So it is better, to ask the person and so you can help. But it can also be a joke from the internet programm, was send in this room. Please take information. I write a book Rediscover Recovery Practical Reference Training. I am a caregiver and therapist for a long time.

Susanngab

September 18, 2013 10:56 a.m.

Dementia is certainly not a fine line.. I now see my doctor once a year (over the last 2 years JUST as a medical doctor! There's been no mention of dementia. I'm busy all day with chores, fixing food and working in the yard, as well as doing many other chores and handling my 2 stock accounts which total 1.45 million dollars. Something just isn't right here.... Michaelh Have a good day now!

Michaelh

September 15, 2013 3:34 p.m.

My father had dementia, and I have been studying it ever since. I have written about the neurological aspects, the utter failure of Big Pharma to offer any help, the global research that is relevant but has not been organized and analyzed, and -- most heartbreaking -- the way in which these dear people are dumped into nightmarish nursing homes and warehoused. I describe people who had been written off as &quot;brain dead&quot; with whom I have developed warm, affectionate relationships. They are not GONE -- they are IN THERE if we take the time to connect. The plight of those with Alzheimer's should be our next civil rights struggle. We will some day look back on how we treated these human beings with shock and disbelief. I have many posts at kronstantinople.blogspot.com. Let's please not forget about these helpless people.

Anonymous

September 12, 2013 4:18 a.m.

One thing I did to help my husband deal with his fear of things being stolen was to install a security system that includes wi-fi cameras as Well as medi alarm. For $60/month he gets peace of mind, I can monitor him from any smartphone or computer and if another person is caring for him I can keep an eye on how they are treating him. Even on a tight budget the peace of mind is priceless. And if something is misplaced you can review the footage in order to find it.

June

September 12, 2013 3:50 a.m.

Sometimes my husbands emtional outbursts seem to come out of nowhere but a new one happened this week that has had me puzzled. We watch an old episode of ER on TV, one of his favorite shows when it was on because of its realism. He used to be a nurse in the ER. But it made him so upset and angry he hasn't been himself since Then, almost like a PSTD situation. This article helps me understand that this is a trigger for him and one I'll avoid in the future.

June

September 7, 2013 12:07 p.m.

Thank you, Angela, for this blog and for all those that have taken the time to post their own experiences. I greatly appreciate all the comments for the insights that each person has as this disease effects their lives.
My 85-yr old father has vascular dementia and it is a roller coaster of emotions along with the ebb and flow of his abilities from day to day.
I find the most pressing problem is finding care givers that he will accept and actually allow them to assist him in his ADLs. Right now I have a great group of women with lots of experience, yet due to things beyond anyone's control he refuses assistance and has forced ER visits to undo the resulting problems.
Personal care and toileting are of great concern for him and the rest of us, but he is not ambulatory anymore and will not soil himself. Therefore he holds it to the point of impaction refusing to drink liquids, take meds, or allow anyone to assist him to the toilet.
Has anyone experienced this? I am open to any and all suggestions!

Kathleen

September 7, 2013 9:56 a.m.

It was interesting to see my situation in light of your article. My husband, who is in our family's opinion, has some kind of dementia after 18 years of being a Diabetic type 2. He is not going to our daughters wedding, which is in MA and we live in NY. His stated reson is that he is not going to ravel and is going to stay at home with the dogs (one of which needs medication 4 times a day). He is also upset with the fact that his daughter has chosen not to be traditional and come home for the wedding at the church where he was the minister for the last 13 years of his ministry before retiring. He is choice was to be the &quot;father of the bride&quot; but now he is not going to do that. I do want suggestions as to how to be respectful so that our daughter's lasting impression of her father is his not walking her down the isle.

Tina

September 6, 2013 5:46 p.m.

This insight adds more speculation to the difference between the sexes over the level of anger that experienced and why. That change makes you wonder what else isn't what it appears to be.

Don

September 6, 2013 5:43 p.m.

Thanks Sue for sharing your thoughts and giving suggestions. It is just heartbreaking for everyone of us to see our loved ones change so drastically from the vital, intelligent family members they once were.

Angela

September 6, 2013 3:31 a.m.

I am internist, my mother,s had dementia she was very emotional sometimes she has h/o asthma ,D.M Type 2,.follow news of this disease,now she dead due to complications of bed rest (same abscess,septic shock )in ICU ,my personal experience in her treatment was
steroid response to short time response but I a m afraid due to stress of side effects,D.C them so I think probably edema of frontal region,is very effective in emotionally movements of diseases my try is find treatment of this frightening disease,my mothers did not now me and told 'who are you boy'. your sincerely,Dr M.

Masoud

September 5, 2013 11:15 p.m.

A recent incident with my 73 yr old brother who suffers from dementia and short term memory loss after a fall reminded me of the article 'Unmet needs and negative behaviors', July 24, 2012.
I had asked him if he'd like a pedicure - he used to enjoy them prior to his fall. He said yes. I made the appointment and did alert the manicurist that there may be a problem as his reactions were sometimes unpredictable.
When we got there and he was already seated, he suddenly got up and said he did not want the pedicure. It was an embarrassing situation as I tried to persuade him with other customers and manicurist watching. Persuasion made him angry and he kept saying,&quot;YOU do it. Just get on with it. Do what you've come to do.&quot;
I gently tried to defuse the situation and said I did not want to do one today and if he didn't want one either we could leave. I went out of the shop expecting him to follow me, but he went and sat in the waiting area of the shop. His personal carer sat with him. I waited outside over 10 minutes but he remained inside with his carer who was trying to get him to leave. Finally his carer came outside and told me he had said, &quot;I didn't bring my wallet, I have no money, no credit card, so how can I do it.&quot;
I felt terrible. Gave the carer money and said to put it in my brother's pocket. I stayed outside out of sight. When I peeped in again my brother was seated and happily having a pedicure. When it ended he paid the manicurist and even offere

renee

September 5, 2013 10:25 p.m.

Thank you so much for this very helpful blog! It really helps me in identifying my husbands behavioral problems. It is so easy to think he is just being difficult but this article helps to see there is a reason behind the behavior.

Nancy

September 5, 2013 7:53 p.m.

My 84 year old father was developing increased paranoia regarding the caregivers in the assisted living home. He is a very kind and spiritual man and very brilliant and gifted - I knew it was the disease taking more control of Dad's head. I took him back to the neurologist who is an AZ specialist with a University. Dad was already taking the Exelon patch and Namenda combination. The Dr. Recommended a low dose of Olanzapine (Zyprexa)be added to his regiman and it has been a life-saver. I take Dad to the doctor every 4 months - sooner if something strange begins. Don't be afraid of medicine - it's God's gift!

susan

September 5, 2013 6:09 p.m.

My neice is only 64 and the docter just tells her, her brain is dying. That when she see something as in a car ahead she doesn't see it quick enough to stop and hit it several times. Now, she is not driving, knows there is something wrong. They do not leave her alone. She loves to walk and while in her own area, became lost and called her husband. She stays with her mother part of the time, and is used to her apartment but now ccannot find the bathroom, doesn't seem to know how to pull up her blue jeans, needs help getting her food. She laughs because she gets so mixed up, and now says she is no good to anyone, she is just in the way. Any suggestions?

Jan

September 5, 2013 6:06 p.m.

I suggest to Tom and Shirley.. try to change the subject to another positive topic..or reply in a way that might be acceptable, or just do not reply. It might be difficult at first, but just like exercise, it becomes easier afterwards. My husband, who was a builder/plumber for 45 years, now brings in his wheelbarrow full of his tools and the lawnmower in our lounge. The first few times he did that I told him to bring the items to his shed, he refused and said his tools would be stolen. I realized then that this thought of &quot;being stolen&quot; stems back to about nine years ago when some of his tools were stolen from his truck. So either argue, which really is exhausting and useless, or just accept the situation. Accepting a situation that I cannot change makes my life easier as a carer. Actually, I make this matter something to be humorous about, adds spice to our daily lives.

Paola

September 5, 2013 5:53 p.m.

I constantly fall short of my own standards in care-giving. I become so frustrated I will say mean things like &quot;I really can't go over all this one more time&quot;, and not surprisingly I reap the rewards... a depressed husband who sits listlessly in the chair, rather than a whistling husband who is busying himself with household chores or whatever. I really must do a lot better. Thanks for this article. I also respond to the comment below &quot;repetition and lack of insight' -- I make sure I have breaks but it certainly takes its toll.

Judith

September 5, 2013 5:38 p.m.

@Angela—My father also has ideas about people in the house, taking things, etc., and I find that it is best not to contradict or argue with him about it, but only to reassure him, saying things like, &quot;This is our home. We are safe here. Nobody else can come into our house unless we invite them.&quot; If he is argumentative about it, it is probably best to try to re-direct. I also find it helpful to sympathize with the possible underlying issue (whatever he perceives it to be, though in this case your mom might not like to do that). For example, with the issue of my dad thinking things are being stolen, I might say: &quot;We don't want people to take our things. That is not right. Nobody should steal things. But this is your table and all your things are safe here. No one can take these things off your table.&quot; Sometimes it helps - sometimes it doesn't.

Sue

September 5, 2013 5:32 p.m.

It is so evident that my 90-yr-old father can &quot;sense&quot; feelings on many levels. He often responds to his caregiver's attitudes expressed through feelings more than anything else. Acting toward him with frustration, impatience, &quot;bullying&quot;, or excessive coaxing causes him to become and hurt and frustrated himself. Instead when I can be sweet, loving and encouraging (not always easy!) he responds in kind and is content and peaceful.
Of course, this is not always the case, as there can be other circumstances that are confusing or hurtful to him, but on the whole I find that he knows whether or not he is being treated with love, respect and genuine concern.

Sue

September 5, 2013 5:04 p.m.

Have to give you credit for addressing an appropriate concern of cargivers/spouse, etc. and I think police officers need education in things they may hear as a complaint, from a person that has possible dementia &amp; AD. Now, I'm in my 7th year since diagnosis and almost 2.5 years in home hospice, full time caring for my wife. I suppose that qualifies me to say some things.
You have made a good case for accepting the reality that the AD patient can be responding/acting in response to their reality as they understand it - just like living through a dream. We have to understand that their behaviors may be guided by their reality which we know is not reality. Assuming we have all of our marbles rolling the right way, hard as it may be, we need to understand their reaction is in response to something real to them, and no ammout of telling them they are wrong or ???? will change them because they are the one who is sick. I try to think &quot;that could be me one day&quot; and just continue to love and care for them.
I take issue with the story about the fellow tucking in his wife's shirt, &quot;, thinking (incorrectly) that she'd forgotten to do so herself, she was clearly humiliated, her eyes bulging out of their sockets so to speak, but this went unnoticed by the husband....I would say the story implies that the husband did something bad, &quot;incorrectly&quot; and his wife was justified in her behavior. Here I must say the husband may have done it 100 times no problem, but h

Gary

September 5, 2013 3:01 p.m.

My 89 yo father gets mad at my 84 yo mother because he thinks there are men coming in the house at night to &quot;visit&quot; her. Under no uncertain terms does this happen. She doesn't do anything to put this thought in his head. Needless to say, this has been troubling for both caregiver (mother) and patient (father). Any suggestions....?

Angela

September 5, 2013 12:59 p.m.

I don't think there is much one can do after the situation &quot;goes sideways,&quot; just continue to be loving and respectful and eventually they will forget and forgive....Sometimes my guy explodes, but it is usually when I have left him with a caregiver who does not engage with him, just leaves him sitting there - Then he feels abandoned and explodes but I see it as a failure to get the right caregiver....(These are respite care visits because otherwise I might lose my mind too! The repetition and the lack of insight is devastating to MY consciousness and I need to get out into the &quot;real&quot; world once in awhile.)

Delores

September 5, 2013 12:52 p.m.

This article helped me better understand my wife's seemingly spontaneous eruptions of rage or resentment for no immediate/timely reason. Later, after the episode subsides, I see that her anger and resentment often comes from a few of her bad feelings toward me. These are long held perceptions of my errors (mostly financial ones), skirt chasing (I have never been a philanderer) and selfishness (I try very hard to put her needs first), to name a few.

Tom2

September 5, 2013 12:35 p.m.

I would like to repeat Tom's question. Does one just drop the subject or try to intervene to lessen the impact of the distress?

Shirley

September 5, 2013 12:07 p.m.

My wife has dementia and she sometimes is angry with her caregiver. She is never angry with me. She says I'm sweet.
But my neighbor's wife transformed her sweet husband into her mean brother and tortured the poor man daily. I felt so sorry for him because he just couldn't understand her transformation of him to a cruel brother he never knew back in Wales.

jOHN

September 5, 2013 12:02 p.m.

I relate to the content of this newsletter article very much. I would call it the &quot;Don't overdo the helping part&quot; or &quot;Let them do what they are able to do even though you can do it much faster - and better.&quot; My wife frequently uses body language to tell me to back-off. For instance, offering her more help than she needed when getting into the car, she sighed with disgust....and then ....stuck her tongue out at me. A behavior never before exhibited.
We both laughed....and then she said:
&quot;Do you want me to drive?&quot;
(She hasn't driven in years)

Richard

September 5, 2013 11:09 a.m.

Thank you for the explanation. Helps me understand some situations.
Is it best to let the patient vent and say nothing in these situations or try to find out the root cause of the anger or emotion.

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